Provider Demographics
NPI:1659597789
Name:MINIMALLY INVASIVE SPINE CARE INSTITUTE - INCORPORATED
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE SPINE CARE INSTITUTE - INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARTYOUN
Authorized Official - Middle Name:ISAAK
Authorized Official - Last Name:YOUSIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-548-1635
Mailing Address - Street 1:1510 S CENTRAL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2583
Mailing Address - Country:US
Mailing Address - Phone:818-548-1635
Mailing Address - Fax:
Practice Address - Street 1:1510 S CENTRAL AVE STE 230
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2583
Practice Address - Country:US
Practice Address - Phone:818-548-1635
Practice Address - Fax:818-247-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty